Joint Impact of Body Mass Index and High-Sensitivity C-Reactive Protein on Metabolic Dysfunction–Associated Steatotic Liver Disease Risk in Type 2 Diabetes

BACKGROUND AND AIMS: Prospective data on the joint impact of adiposity and systemic inflammation on incident metabolic dysfunction-associated steatotic liver disease (MASLD) in type 2 diabetes (T2D) are limited. We examined the individual and combined associations of body mass index (BMI) and high-sensitivity C-reactive protein (hsCRP) with incident MASLD in patients with T2D. MATERIALS AND METHODS: ) and hsCRP (<3 vs. ≥3 mg/L). Multivariable Cox models estimated hazard ratios (HRs) for incident ultrasonographic steatosis. RESULTS: The cumulative incidence of MASLD was 53.9%. Higher BMI: and hsCRP were independently associated with increased risk. In joint analyses, the high BMI/high hsCRP group had the highest risk [adjusted HR: 2.31; 95% confidence interval (CI): 1.94-2.74] compared with the low BMI/low hsCRP group. This risk was greater than isolated high hsCRP (HR: 1.37) or isolated high BMI: (HR: 1.93). CONCLUSIONS: Elevated BMI: and hsCRP are independently associated with incident MASLD in T2D. Co-elevation of both factors confers the greatest risk, suggesting that incorporating both adiposity and inflammatory markers improves risk stratification for targeted preventive strategies.